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Spasticity

Spasticity is a condition in which certain muscles remain contracted. The contraction causes stiffness or tightness of the muscles and can interfere with normal movement and speech. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. The damage causes a change in the balance of signals between the nervous system and the muscles. This imbalance leads to increased activity in the muscles, particularly the muscles of the arms and legs.

Spasticity affects more than 12 million people worldwide including those with:

  • Cerebral palsy
  • Multiple sclerosis
  • Traumatic brain injury (TBI)
  • Spinal cord injury (SCI)
  • Brain damage due to a lack of oxygen
  • Stroke
  • Encephalitis
  • Meningitis
  • Adrenoleukodystrophy
  • Amyotrophic lateral sclerosis (Lou Gehrig’s disease)


Common Symptoms

Spasticity may be as mild as a feeling of tightness in muscles or severe enough to produce painful, uncontrollable spasms of the arms and legs. It may also create feelings of pain or tightness in and around joints, and cause low back pain.

Problems associated with spasticity include:

  • Muscle stiffness
  • Muscle spasms
  • Involuntary crossing of the legs
  • Muscle and joint deformities
  • Muscle fatigue
  • Inhibition of longitudinal muscle growth
  • Inhibition of protein synthesis in muscle cells
  • Urinary tract infections
  • Chronic constipation
  • Fever or other systemic illness
  • Pressure sores


Treatment

Your treatment will be personalized to your condition. Treatments share the common goals of:

  • Relieving the signs and symptoms of spasticity
  • Reducing the pain and frequency of muscle contractions
  • Improving gait, hygiene, activities of daily living and ease of care
  • Reducing caregiver challenges such as dressing, feeding, transport and bathing
  • Improving volunteer motor functions by reaching for, grasping, moving and releasing objects


Depending on the cause of your spasticity, treatment may include:

  • Physical and occupational therapy including stretching and strengthening exercises, temporary braces or casts, limb positioning, application of cold packs, electrical stimulation and biofeedback
  • Medications such as baclofen, benzodiazepines, dantrolene sodium, imidazolines or gabapentin
  • Botulinum toxin injections


The primary surgical procedures used to treat spasticity are intrathecal baclofen (ITB) pumps and selective dorsal rhizotomy (SDR).

In severe cases of spasticity, baclofen can be administered through a pump that has been surgically implanted in the patient’s abdomen. Delivering baclofen directly to the spinal fluid achieves a much more powerful reduction in spasticity and pain with fewer side effects. ITB has been found to be very effective in treating spasticity in the arms and legs.

In selective dorsal rhizotomy, the neurosurgeon cuts selective nerve roots (rhizotomy), the nerve fibers located just outside the backbone that send sensory messages from the muscles to the spinal cord. SDR is used to treat severe spasticity of the legs that interferes with movement or positioning. Muscle stiffness is decreased, while other functions remain intact. Decreasing spasticity can improve mobility and function, and help prevent severe muscle scarring, as well as joint and bone deformities. It is most effective in patients with cerebral palsy who meet specific criteria.

The benefits of surgery should always be weighed carefully against its risks. Randomized, controlled clinical trials have demonstrated that a large percentage of cerebral palsy patients report significant reduction in spasticity and improved function after surgery. However, surgery is not an option for all cases of spasticity.

Source: American Association of Neurological Surgeons

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